Attention Deficit-Hyperactive Disorder: Addiction s Perfect Storm

Transcription

1 Attention Deficit-Hyperactive Disorder: Addiction s Perfect Storm Presented by April 6, 2016

2 Thomas Durham, PhD Director of Training NAADAC, the Association for Addiction Professionals

3 Produced By NAADAC, the Association for Addiction Professionals

4

5

6 Cost to Watch: Free CE Hours Available: 1 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $15 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

7 Using GoToWebinar (Live Participants Only) Control Panel Asking Questions Audio (phone preferred) Polling Questions

8 Webinar Presenter Beth Donnellan, M.Ed, ABD, FT Contact: (813) Your Kaplan University School of Social and Behavioral Sciences B.S. in Addictions Program

9 Webinar Learning Objectives The participant will be able to explain the imbalance of impulsivity and cognitive control in ADHD diagnosed teenagers and adults. The participant will be able to apply specific prevention/treatment strategies to case studies of ADHD addicted clients The participant will be able to describe the psychopharmacological mechanism of stimulants in ADHD diagnosed brains.

10 Attention-Deficit Hyperactive Disorder Defined Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level: Often has trouble holding attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often has trouble organizing tasks and activities. Is often easily distracted Hyperactivity and Impulsivity: Often unable to play or take part in leisure activities quietly. Is often "on the go" acting as if "driven by a motor". Often talks excessively. Often blurts out an answer before a question has been completed. Often interrupts or intrudes on others (e.g., butts into conversations or games)

11 Facts: ADHD in United States *estimated 11.4% or 6.4 million children, teens, and adults diagnosed with ADHD *true diagnosis rate estimated 7.8% (misdiagnosis often in younger children) *roughly 25% of adults in treatment for a substance use disorder are ADHD diagnosed *most who are diagnosed are offered stimulant prescription only *Adderall and similar stimulants are similar amphetamine structured *children and teens likely to suffer symptoms of conduct problems (e.g. conduct disorder), lack of emotional regulation, and trouble encoding social cues *adults continue to suffer symptoms related to dysfunctional relationships, poor decision-making, and low emotional regulation *highly correlated with average to above average intelligence

12 Basic Memory Model in non-adhd Brain

13 Memory Model with Sensory Filter

14 ADHD: Problem Without Sensory Filters

15 How Do Stimulants Work In ADHD TX? Norepinephrine, which is a key neurotransmitter, along with its building blocks, dopa and dopamine are not used properly in the brain (ADHD diagnosed). The primary medications used to treat ADD/ADHD stimulate specific cells within the brain to produce more of the deficient neurotransmitter. When stimulant type and dosage level are appropriate (for ADHD diagnosed client), an artificial buffer is created between sensory and working memory components of memory.

16 Stimulants increase both fine and gross motor control as well as cognitive performance and executive function. In other words, stimulants can improve handwriting and sports performance as well as behavior and attention. (ADHD diagnosed) Stimulant medications including amphetamines (e.g., Adderall) and methylphenidate (e.g., Ritalin and Concerta). There are new nonstimulant drugs that are prescribed now too (e.g. Intuiv). In an ADHD brain, stimulants work as a sensory filter that helps the brain focus (reverses the natural altered state with dopamine flooding). In a non-adhd brain, there is focused attention, but also dopamine flooding that creates an altered state. Dopamine helps regulate attention Over time, an ADHD brain adapts to dopamine increase by developing more dopamine receptor sites (why adults need a different medication).

17 ADHD Medication Chart: Amphetamine Class Drug Name Form Duration Common Side Effects AmphetamineStimulants Adderall Dexedrine Short-acting Short-acting 4-6 hours Some loss of appetite,weight 4-6 hours loss,sleepproble Dextrostat Short-acting ms, 4-6 hours irritability,tics. Short-acting medicines require frequent dosing. Dexedrine Spansule Long-acting Adderall XR Long-acting 8-12 hours Vyvanse Long-acting (prodrug) 6-8 hours Some loss of appetite, weight loss,sleepproble ms, irritability, tics. Longacting medicines are convenient but may have greater effects on appetite and sleep.

18 ADHD Medication Chart: Methylphenidate Focalin: Short-acting 4-6 hours Some loss of appetite, weight loss, sleep problems, irritability, tics. Short-acting require frequent doses. Ritalin Short-acting 3-4 hours Ritalin LA Intermediate 8-10 hours Same side-effects, however greater impact on appetite and sleep Concerta Long-acting hours Same side-effects as intermediate drugs Daytrana Long-acting hours *NOTE- non-stimulant medication research suggests that these are not as effective.

19 ADHD = Greater Risk for Addiction ADHD = sensory flooding, problems with sorting most important stimuli -distraction that comes from need to sort/prioritize stimuli -impulsiveness that comes from lower emotional regulation (e.g. wanting peer approval) -risk for developing anxiety disorders (fear of future based on inability to read environmental cues) Cognitive override: Even when a teen/adult knows that situation is risky, they often overestimate their ability to navigate the situation. Result: Teens age 17 and younger, higher drug experimentation and addiction (Center for Disease Control, 2014). Nicotine 17% ADHD vs 8% nonadhd Daily marijuana use 13% vs 7% non ADHD

20 Why are ADHD diagnosed teens are at greater risk for developing substance use addiction? a. medication used to treat ADHD increases the risk of using other drugs b. their brains have a harder time managing distraction and impulsivity c. they have greater access to drugs and alcohol than other teens do d. they are unaware of the risks of drug and alcohol use

21 Adolescence = +risk taking and emotional regulation At age 14, risk taking impulse is mature (strong drive) At age 25, cognitive control is mature (e.g. weighing consequences, problem-solving) In ADHD brains, risk taking continues to be strong from age 14 through adulthood with less mediation from prefrontal cortex.

22 Societal Teaching: Emotions Basic Human Emotions Fear Happiness Disgust Anger Sadness Males Society allows: happiness, disgust, anger Societal discouragement: sadness, fear Females Society allows: happiness, disgust, fear, sadness Societal discouragement: anger

23 ADHD diagnosed teens/adults who take prescription medications regularly are at higher risk for developing a substance use disorder. True False

24 Increased Substance Use: ADHD Diagnosed Reasons for increased substance use: -attempt to moderate the perception of sensory stimuli to keep from being overwhelmed -increase dopamine to help them feel better (high) -not properly diagnosed and use of alcohol/marijuana/illicit drugs to escape -attempt to self-medicate to cope with life dysfunction such as relationship and employment problems -(teens) belief that peers use and perceived social support for use -lack of ability to read social cues- social awkwardness, poor judgement Compared to Overall Risk Factors for SUD

25 ADHD-Risk Factors -high impulsivity -low emotional regulation -low understanding social cues -high conduct problems -high academic problems -high problems w/relationships (family, peers, authority) Prevention/Tx -family counseling -drug education -role play/ social skill building -cognitive training -if indicated: prescription drug At-Risk for SUD -early initiation of problem behavior -academic problems -family attachment problems -impulse control

26 Scenario: Bob 16-year old male Scenario: Prevention/Treatment Bob was diagnosed with ADHD at age 8 and has been taking Adderall. He was held back a year (third grade) in school because of problems with reading. His academic performance is now above grade level. However, in the past four months, his grades have fallen to failing. He has been suspended twice and was caught with marijuana on campus. He admits to selling his Adderall (not taking it). He reports that he has only started smoking marijuana.

27 If you were to work with Bob in a prevention/treatment setting, which of the following strategies would you use? a. recommend that he return to taking Adderall b. role play (e.g. refusal skills) c. dual diagnosis residential treatment d. alternative school transfer

28 Integrated Treatment Plan Teens and adults who are ADHD are often most addicted to alcohol and/or marijuana. Those who are diagnosed with co-occurring Alcohol Use Disorder and ADHD require integrated treatment. Effective treatments: -behavior modification (e.g. ADHD is treated successfully with this) -continued/monitored use of prescription medications -social skill training/relationship counseling (e.g. couple, family) -standard SUD treatment goals -organization skills (including planning and life skills)

29 Scenario: Adult ADHD and Alcohol Use (Disorder?) Kylie is a 46 year old female who was diagnosed with ADHD when she was 24. Her PCP prescribed Ritalin at the time of diagnosis. Kylie did not like how it made her feel, so she stopped taking it after two years. She reported that she did not take any medication for her ADHD for the next 20 years. Two years ago, she saw a psychiatrist who prescribed Adderall XR. She is married (23 years), has two children, and one (her son) is also diagnosed ADHD. She has been successfully employed with a major telephone company as an executive sales manager. She reports that while she earns a lot of money, she never has any of it. Her home office is so disorganized, that she cannot work in there anymore. There have been layoffs at work recently requiring her to work 15 hours more a week. She reported lack of sleep, weight gain, and overall feeling of defeat from her inability to organize and spend time with her family. She further reported that she began drinking at night to help her sleep. She began with 2 glasses of wine nightly to 4 now. She thinks that her medication is a problem.. is it?

30 Actual client case- her treatment included: - diet, stress reduction strategies - organization, prioritization training (practice, role play, journaling) - Kylie discussing her alcohol use with her psychiatrist (this had been kept secret) - alcohol treatment- outpatient + ADHD support group (CHADD) *Considerations: Scenario: Kylie -client reported feeling overwhelmed, stressed do not send to multiple treatment facilities/professionals -has learned survival skills, use those strengths to build even more functional skills

31 References Barkley, R. A., Murphy, K.R., & Fisher, M. (2008). ADHD in adults. New York, N.Y: Guilford Press. Bush, G., Luu, P., & Posner, M.I. (2000). Cognitive and emotional influences in anterior cingulate cortex. Trends in Cognitive Science, 4(6), Gallucci, A. R., Martin, R.J. & Usdan, S.L. (2014). The diversion of stimulant medications among a convenience sample with current prescription drugs. Psychology of Addictive Behaviors, 29(1),

32 Thank You! Beth Donnellan, M.Ed, ABD, FT Contact: (813) Your Kaplan University School of Social and Behavioral Sciences B.S. in Addictions Program

33

34 Cost to Watch: Free CE Hours Available: 1 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $15 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

35 Upcoming Webinars April 20, 2016 June 1, 2016 Life After Incarceration: The Current Policy Landscape and a Toolkit for Professionals that Work with the Criminal Justice Population By Frank Greenagle May 18, 2016 Your Healthy Self: Skills for Working with Codependent Behaviors By Nancy Johnston Trauma-Sensitive Mindfulness Practice as Recovery Maintenance By Angela Jones June 22, 2016 The Science of Recovery: Introduction to Brain Development and Neuroplasticity By Joseph Christensen

36 Free CEs for Members Levels: Professional Associate Student join

37 WEBINAR SERIES Over 75 CEs of free educational webinars are available. Education credits are FREE for NAADAC members. MAGAZINE ARTICLES In each issue of Advances in Addiction & Recovery, NAADAC's magazine, one article is eligible for CEs. FACE-TO-FACE SEMINARS NAADAC offers face-to-face seminars of varying lengths in the U.S. and abroad. INDEPENDENT STUDY COURSES Earn CEs at home and at your own pace (includes study guide and online examination). CONFERENCES NAADAC and AAPA s 2016 Annual Training Institute, May 2-3, Anchorage, AK 2016 Annual Nebraska Behavioral Health Conference, May 31-June2, Lincoln, NE CERTIFICATE PROGRAMS Demonstrate advanced education in diverse topics with the NAADAC Certificate Programs.

38 2016 Annual Conference Join us from October 7-11, 2016 in Minneapolis, Minnesota for the NAADAC Annual Conference, Embracing Today, Empowering Tomorrow. Visit for more information and to register!

39 Contact Us! NAADAC 1001 N. Fairfax Street, Suite 201 Alexandria, VA phone: / fax: / naadac@naadac.org NAADACorg Naadac NAADAC